Friday, May 31, 2013

As part of the project on Climate Change, I wonder whether we can look at quail farming as a livelihood in this region. The wild variety of quail, locally called 'teethar' is quite a local delicacy. It is illegal to kill it, but it's commonly available in most of the local dhabas (roadside hotels).

Quail farming is quite a major business in South India.

Below are snaps of quail egg, which is quite favoured by our children. It's quite commonly available in grocery stores in Trivandrum.

Would appreciate feedback on whether anybody has tried 'quail farming' in Bihar/Jharkhand region.

Now if you look carefully at the composite picture of the night sky of the country, please note where the coloured lights come in. According to the article in The Hindu -

- Blue lights indicate city lights that became visible in 1992

- Green lights indicate city lights that became visible in 1998

- Red lights indicate city lights that became visible in 2003

And please re-look at where our mineral wealth and more importantly forest cover of our country is. Yes, it is in these regions that we've been having population influx and growth as the years pass by, except for the North East part of the country.

GP did not have any idea of what would happen to him on the 21st of May. He had been doing quite well over the last 2 months. More so, because the RSBY has enabled him to get cataract surgery done on his right eye.

But, GP's cow had other plans for the day.

While taking his cow back from pasture, the cow charged at him and the next thing he knew was that he has badly injured in his right eye. He had continued to wear his black glasses given after the the cataract surgery.

He was rushed to NJH and he reached us by 6 pm.

For Dr. Pradhan, our ophthalmologist, the first option was to refer to a higher centre in Ranchi. GP had a rupture globe, iris prolapse and blood in the anterior chamber - a nightmare for any doctor. The lens was just spared of any violence.

GP was poor. He had done his cataract because RSBY helped him. He could not afford the transport and stay at Ranchi. The family took the option to do the treatment here.

Early
morning, I was informed of a very complicated patient in the labour room. LD, a
26 year old lady has been in labour since Saturday early morning. She has been running
from hospital to hospital trying to get some help. The problem was that she had
a hemoglobin of 6 gm% and nobody was willing to take her. To make matters
complicated she had been given injection pitocin elsewhere. She had a pregnancy
couple of years back. The baby had died just after childbirth after she had
attempted a home delivery.

She was O
positive. Dr. Johnson tried to arrange some staff to donate when she reached
late night on Saturday. Unfortunately, we do not have many staff with O positive
blood group. There was only one option. Either the patient had to be referred
or we had to do the surgery with a consent to do without blood which was not a
easy choice. The family having had visited quite a few hospitals before entering NJH had already spent
quite a lot of money on her ‘treatment’. So, the question of going to Ranchi
was totally out of question.

However, we
decided to wait for blood to come.

It came . .
. by around 11 am on Sunday morning. It had been a full 33 hours since she had
been in labour. And she was into obstructed labour.

I opened
and found the worst I had feared. The uterus had ruptured. The baby was alive
but quite sick. The endometrium and placenta was grossly stained with meconium.
The baby died by evening. LD lost quite a lot of blood. She is on the
ventilator and fighting for her life.

As we were
doing LD’s Cesarian section, rather laparotomy, in came SeD.

Frighteningly,
SeD also had a history similar to LD.

SeD was
brought by her parents. Her father, a wizened old man who had quite a lot of
creases on his face was a sorry figure.

The history
. . . SeD had also been in labour since the previous day. The family had been
to many hospitals. She was also told that her hemoglobin is 6 gm%. And her baby
was in an abnormal position. The nurses could not get the fetal heart. I was in
a hurry.

I told them
to push SeD into the ultrasound. I had a cursory glance at the fetus. The
heartbeat was going strong and was a footling breech. No other choice than to
do a Cesarian section.

I did not
think twice. She was B positive. I send word to 2 of our staff requesting to donate
blood. SeD was having very strong uterine contractions. I did not want SeD to
end up with the same outcome as LD. Ebez George, our Project Officer and Dr.
Basil, our Dentist were were happy to donate.

We did the
Cesarian in no time. To my surprise, SeD had a twin pregnancy. Mother and
babies are doing well. I had missed that in my ultrasound screening.

I wondered
why we did not have a staff with O positive blood who could help LD and her
baby. They would have done better. The baby would have been alive.

But, a
terrible thing happened later. I went to see SeD’s father. He had narrated to
me SeD’s sad story. SeD had also delivered 2 years back, but the baby had died
soon after her home birth. When SeD got into her present pregnancy, SeD’s
husband took her and left at her parent’s home and told them not to send her
back if she did not have a live baby this time.

I was
congratulating myself as I saw SeD’s father standing at a distance and was happy that I had good news.

I could
only watch with horror the pain that SeD’s father’s voice echoed when he came
to know that his daughter had delivered twin girl babies. The creases on his
face becoming deeper as he pondered aloud, ‘Doctor saab, I wonder if SeD’s
husband would come to take her back with the 2 girl babies’.

Please pray
that LD would recover well and SeD’s husband feels proud to be the father of 2
daughters.

Thursday, May 23, 2013

Last week, as I travelled from Alleppey to Ranchi, few of my staff called me and told that there were very few buses available from Ranchi to come to NJH as it was 'lagan season'.

'Lagan season' is the season of marriage in this part of the country. The connotation is for the auspicious period when marriages can take place. The present marriage season has started from sometime during the second week of May and will extend to the last week of June. Someone told me that it could go all the way to the middle of July.

Why the great interest in the 'Lagan season' for NJH?

It's all about the hospital becoming busy. The patient numbers come down to a great extent during this season. The reasons . . . everybody is going to someone's wedding. There are no vehicles to come to hospital as most of them will be booked by marriage parties.

Soon after I arrived at NJH last Sunday, I had gone for a haircut. The barber and few of the customers were surprised at my decision to come back so soon after I had left for Kerala. One villager quipped, 'Sir, you should have taken a longer break. It's so hot and it's marriage season. There will be hardly any patients'.

But, we've not been so much derived of patients. There's quite a good number of patients coming to outpatient as well as inpatients. We've been busy.

Then, we receive patients who just want to get cured just in time for a wedding in the family. Basil is quite used to young men and women who want to have a perfect teeth just in time for the big day. I had a family whose middle aged mother was dying of tuberculous meningitis, who wanted me to keep the lady alive till a wedding in the family was over. But, then that never happened.

2 years back, I had a peculiar request. A father and his son who going to getting married in a couple of days came to Outpatient. The father wanted me to ensure that the son did not cough even once when the wedding ceremony was going on. He just wanted me to prescribe a cough syrup. And the son was totally asymptomatic.

I sometimes wonder how the concept of the 'Great Indian Wedding' has permeated to the rural areas of the country . . . when the whole world stops, when there is a wedding in the village.

Wednesday, May 22, 2013

I took first call last Monday after quite a long time. It was quite a busy one and got quite a wide array of cases which would have put a Medical College to shame, especially the newly opened ones.

But, the best case was the first Cesarian I did for the day. A usual case of 'you know what'.

It was about 9 pm. I was just planning to go for dinner when CJD, a 35 year old lady arrived in labour room. She had been trying to deliver at home since early morning. With the sort of heat we've been having of late, she was so dehydrated and worn out. To complicate matters, she had undergone a Cesarian section for her last child birth which was 2 years back.

That was the last thing I wanted after a quite busy day in outpatient.

And after the details emerged . . . I was sure I was sitting on top of a time-bomb.

Cesarian done 2 years back while she was preterm. The baby was a girl who was just 1800 gms. The family was of course quite anxious for a boy. And her blood group was A negative.

Per vaginal examination revealed that the labour was obstructed. I initially thought about doing a instrumental delivery, but I was not confident about the outcome, especially the chance of a rupture uterus.

From the onset, I tried to refer CJD to Ranchi. But, the family looked hardly bothered. We have a protocol of not doing a repeat Cesarian section without the provision of at least one unit blood. And it was difficult to get a pint of A negative blood. And the family had made no effort to even think about it, leave alone arrange it.

I had to take a decision and go ahead with some intervention. After much dialogue, I agreed to take her for a Cesarian section. The hemoglobin was 10 gm%.

The Cesarian was a mess. There was too much adhesions.

The baby was sick. And continues to be sick. And it was a girl.

We asked the mother whether the family knew that the baby was a girl.

However, considering the attention the family never gave to CJD, I wonder if they knew well in ahead that the fetus was a girl.

The baby is very sick. We've been telling them to take the baby to a higher centre. But, they are hardly bothered.

And CJD was the first patient of the night. I became free only at 5 am the next day. There were 2 more complicated labour patients, who needed Cesarian section and then one elderly man with a myocardial infarction. But, then the list of patients with the varied hue of diagnoses of the day, in another post.

Tuesday, May 21, 2013

Today
morning, I met the Principal of Sacred Heart School, Daltonganj where quite a
many of the children of our staff study. She was quite elated over the success
that her wards achieved in the tenth standard exams.

1. Dr. Roshine
Mary Koshy, our new Internal Medicine consultant has passed her MD exams. We
praise the Lord. And we request prayers as she makes the transition to NJH.

2. I was away
for about 2 weeks. I thank Lord for the leadership given by Ms. Meghala and Dr.
Shishir in my absence.

3. Please pray
for Dr. Titus and Dr. Grace who’ll be getting married on May 20th
and Mr. Dinesh and Sr. Priscilla who gets married on May 30th.

4. We are in
the process of consolidating the achievements of the previous years. We thank
the Lord that the auditing went about without much hitches.

5. We continue
to remain empanelled under RSBY. However, there are major issues with
compensations which is a major deterrant for the smooth functioning of the program.
Please pray that all problems will be ironed out.

6. Drs.
Nandamani and Ango plan to be with us at NJH from the 22nd June to 2nd
July. Please pray for their travel and other arrangements.

7. There is a
small window period in the first 2 weeks of June, when we are going to be
really short of doctors. Kindly pray for this time. Please encourage doctors
who can help out to contact us.

8. At EHA, we’ve
making an effort to remind ourselves that we are primarily here as spiritual
leaders. At NJH too, we are well aware of the need for us to lean more on the
Lordship of Jesus Christ. We request you for prayers that we will grow in the
Lord, our fellowship will be an offering of sweet fragrance to the Lord and we
will be a blessing to each person whom we deal with, staff and patient.

9. Quite a lot of our staff are on summer holidays.
Kindly pray that they would have a good time of rest and refreshment. Do uphold
the team who’s taking the extra burden in the absence of the staff.

It was
midnight of a really hot summer. The hospital was not very busy. I was called
to attend to a girl, about 12-13 years old who presented to emergency with
severe breathlessness.

On
attending to this girl whom we shall call AK, I realised that I was dealing
with a long term cardiac condition, most
probably a congenital cardiac disease with end stage cardiac failure.

The X-ray
confirmed it. Her heart occupied almost the whole of her chest. The veins in
her throat were all bulged up. Her eyes were bulging and was very congested.
She had central as well as peripheral cyanosis. I could not record her blood
pressure.

I put her
on the bed in the acute care. I called one of my colleagues who confirmed that
nothing much can be done other than make her feel comfortable.

I talked to
her parents. In fact, AK had been sick from the day she celebrated her first
birthday. They had not shown her to a proper doctor. Only quacks (jhola chaps)
and faith-healers (ojhas) had seen her. The family appeared to understand that
there was nothing much to do other than pray.

I went to
talk with AK. To my surprise, AK also was sure that she was dying. As I told
her that I shall see her in the morning and was leaving, she clinged to my
hand.

In between
her breathlessness she told me, ‘Please ensure that I die here in this place.’
I told her that my nurses will take care of her well. Then she continued,
‘Doctor, I’ve never slept on a bed. I never knew that it is so comfortable.
Please let me die on this bed’.

AK died
early morning, before I reached for rounds. Her face was so peaceful. Not the contorted
faces that I’ve seen in many of my patients who die a horrible death after
being breathless.

All she
wanted was to remain in the bed on which she ultimately died.

Tells a lot
about basic human needs and wants, especially those of the poor.

Friday, May 17, 2013

Patients
teach us a lot about life. And I’m sure that they are not one-off incidents. I’m
thankful for these patients who instilled qualities in me which I value very
much.

The first incident occurred during my previous stinct at NJH. Ms. RK was a 9 year old
girl who came to us with a perforated intestine, most probably following
enteric fever. The family did not look poor to not afford surgery at our place.

The treatment
which included surgery went on without any hitches. Their total bill had come
to around 12000 INR. Since there was not any complications and the admission
period was uneventful, we did not remember much about RK and her family.

Not until
about 6 months later.

I had been
part of setting up a TB Clinic at another hospital about 100 miles away from
our place. I usually travelled to this place by jeep early morning.

In one of
the trips, I stopped at a wayside shack for tea early in the morning, when this
middle aged man who was making the tea came out of his shop and touched my
feet. He told me that we had saved his daughter’s life some time back.

I could not
place the identity of the family till RK came running out from behind the
shack.

The shack
comprised mainly of 4 heavy pieces of wood in the corners and plastic sheets
and sack cloth dividing the space into 3 rooms. Bricks were arranged in a very
haphazardous manner to make the outer walls.

It took me
some time to recognise RK.

I was
surprised at the severe poverty in which the family lived. The father was ready
with the tea.

As I sipped
the tea on that cold winter morning, I asked the father how he was able to pay
our bill 6 months back, considering the poverty he was in. I was in for a
shock.

The father
replied, ‘We had seen better times till RK fell sick. By the time, we reached
your hospital, we had already spent about 20,000 for RK’s treatment. It was
just after planting our crops that RK fell sick. So, I did not have any money
with me. Therefore, we had to take a loan from the local money lender.
Unfortunately, the crops failed because of a poor monsoon. We had to sell our
home and the little land that we had to repay the money lender. After that, our
life has been this shack.’

He took me about 50 metres down the road and pointed to a hut, much better than their present residence and told me that they used to live there before RK fell sick.

The winter
appeared to sort of envelope me in a terrible chill when I heard this.

We had not even
bothered to ask the family about their resources when they came to pay their
bill.

The family
was very thankful that their little girl did well after our treatment. There
was no hint of any remorse in the father’s or the family’s conversation with us
about the poverty they were dragged into because of their daughter’s illness.

But, I
learnt a very important lesson. I’ve heard only about statistics of how 40% of
poverty was caused by ill-health in the family. I was seeing a real life story of one of our
patients.

From then
on, I make it a point to enquire if our patients our selling their only
possessions to pay their healthcare bills. Yeah, the situation has occurred because
of a poor public healthcare system.

I’m sure
that I may be taken for a ride by many of my patients when they know about my
attitude towards patients who have to sell their land or homes to pay for their
treatment.

However, I
believe that there will be genuine patients who’ll be benefited for life if we
enquire about where their resources come from.

The
ultimate answer would be to push for a well oiled and competent public
healthcare system.

But till that happens,
mission hospitals like ours can make a difference in the lives of at least few
of such families.

As always, the visit to my home at Trivandrum also included a visit to the zoo. It must be the 7th or the 8th time that Shalom has visited the zoo. This time, he was very specific. And it was special for us as Chesed was visiting any zoo for the first time.

Shalom was sure about what he wanted to see. Yeah, the big animals . . . He bypassed most of the enclosures of the smaller animals in favour of the bigger ones. He was not disappointed.

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Translator

Welcome

I'm Jeevan. Along with Angel, my wife and four energetic kids - 2 daughters, Charis (6 years) and Hesed (4 years) and 2 sons, Shalom (9 yrs) and Arpit (2 years), we live in a remote town in North India.

We serve at a small dispensary attached to a Catholic mission which in addition to the clinic also has a parish and an ICSE school. We serve the most poor, backward and marginalised groups in the surrounding community. I use this blog to share about the people whom we serve and care for and our lives.